Summary of the impact

Research by David Paton and Sourafel Girma has raised awareness, informed critical public debate and affected policy decisions in the area of adolescent sexual health on a national and international level. The Irish Law Reform Commission, Local Authorities, a Parliamentary Enquiry and non-governmental organisations such as the Family Educational Trust have used key research insights to inform policy and practice including the withdrawal in Ireland of a proposal on the provision of contraception to minors. The research has been used extensively by policy makers, commentators and the media to debate which interventions are most effective at reducing teenage pregnancy rates in many countries including the UK, Ireland and the USA.

Underpinning research

Achieving reductions in rates of teenage pregnancy and sexually transmitted infections (STIs) has been an explicit objective of many governments over recent years. Although the provision of family planning services to adolescents is often a central part of policies to achieve this objective, before this research there was only limited empirical evidence on actual impact of such policies on adolescent pregnancy, abortion and STI rates. The research programme, initiated in 2001 by David Paton and joined by Sourafel Girma in 2005, was designed to contribute to the evidence base on this question.

The focus of the research has been on the use of economic models to examine the impact of sexual health policy on decision-making by teenagers in the areas of sexual activity, contraception and pregnancy. A theoretical model of teenage decisions was developed [1] which led to a series of specific predictions about the effect of factors such as access to family planning on teenage pregnancy and abortion rates. This paper and later work published in [2], [3], [4], [5], [6] produce empirical estimates of the actual effect of particular policies relating to family planning access and sex education as well as a range of socio-economic factors such as unemployment and education achievement.

A key insight of the research is that decisions on sexual activity, contraception and pregnancy are fundamentally interrelated. As a result, policies aimed at reducing teenage pregnancy rates by, for example, improving access to family planning may have the unintended consequence of increasing the overall rate of teenage sexual activity. Given the relatively high failure rates of many forms of family planning amongst teenagers, the effect on pregnancy rates is ambiguous. The empirical work concluded that access to family planning has a relatively small effect on teenage pregnancy and abortions relative to the effect of socio-economic factors such as education and family breakdown (measured by children in care). In particular, [1] and [6] find that mandatory parental consent for the provision of family planning to minors does not lead to an observable increase in pregnancy or abortion rates.

Furthermore, measures to tackle teenage pregnancy may have unintended consequences on other outcomes such as STIs. In this respect, [4] finds that local authorities in England that promoted the free distribution of emergency birth control (the `morning after pill') to teenagers at pharmacies experienced relatively bigger increases in diagnoses of STIs than other authorities.

Key researchers:

Professor David Paton (UoN Business School from 2000 to current, Professor of Industrial Economics);

Sourafel Girma (UoN Business School from 2005 to August 2011 as Associate Professor then Professor of Industrial Economics; UoN School of Economics thereafter)

References to the research

Details of the impact

This body of research has influenced policy and informed policy debate and public discourse in the area of adolescent sexual health by dissemination of research findings through press reports, public events and invited presentations. It has raised awareness amongst policy-makers, public bodies, commentators and NGOs working in the area of adolescent sexual health. The research has been used, in particular, by numerous NGOs both to hold existing policy makers to account and in their submissions to consultations on proposed policy changes both in the UK and overseas. The research has directly influenced the withdrawal of a policy proposal in Ireland.

Organisations such as the Family Educational Trust (UK), the Iona Institute (Ireland) and the Family Research Council (USA) have used specific empirical evidence in the research to underpin the policy advice they provide in submissions to Parliamentary Enquiries and other policy reviews. For example, policymakers in Ireland have received revised advice from the Irish Law Reform Commission regarding provision of contraception to minors.

Commentators in the print, broadcast and online media have drawn on the research for public policy debate about which interventions are most effective at reducing teenage pregnancy rates in many countries including the UK, Ireland and the USA.

Influencing policy in the Republic of Ireland

In 2010, the Irish Law Reform Commission [B] proposed to amend the law in Ireland such that minors from the age of 12 could access contraceptive services under some circumstances without parental consent partly on the grounds that this would contribute to a reduction in pregnancy rates amongst this group. The Iona Institute submission to this consultation [C] drew extensively on Paton's research (in particular findings in [1], [2] and [3]) to argue against the basis for the proposed change. This was supported by print and broadcast media uptake of Paton's work to highlight the issue and stimulate public debate, notably in the Irish Herald (28^th March 2010), the Irish Times (27^th March 2010) and the Pat Kenny programme on RTE 1 [J] which included an interview with Paton.

In the response to the consultation, the Irish Law Reform Commission revised their original recommendation regarding parental consent for contraception for minors [D, pages 102-3].

Mr David Quinn, Director of the Iona Institute has commented:

"The Iona Institute submission to the Irish Law Reform Commission on the provision of contraception to minors drew extensively on Professor Paton's research on teenage pregnancy. The submission was the only one to our knowledge which set out the evidence showing that providing contraception to minors does not reduce the pregnancy rate among teenagers. Professor Paton's presentation of the submission in Dublin was attended by members of the Law Reform Commission and almost certainly influenced their decision to alter their original recommendation that underage teenagers be provided with contraception without parental permission." [E].

Informing policy debate and public discourse

In the USA, findings from [3] and [4] have been cited in on-going policy discussions over the Health and Human Services (HHS) proposals to mandate contraception coverage in all health insurance schemes. Selected examples include The Washington Post [G], citation in the Family Research Council's submission the Health Subcommittee Hearing [B, page 5] and in the National Review Online [K].

In the UK, findings from the research programme have been used to subject proposed changes in public policy to public scrutiny. Both 2008 and 2010-12 have seen significant UK Government reviews and consultations on sex education policy, focusing in particular on proposals to make sex and relationships education (SRE) content statutory for schools. The findings in [2], [3], [4] and [5] were cited and discussed in submissions to these consultations by several NGOs, including the Family Education Trust, in opposition to the proposals. As a result of the consultations, the proposed change to SRE did not come onto the statute book, an outcome that seems likely to have been partly informed by representations made by these groups which referenced the research.

Dr Trevor Stammers of the Family Education Trust comments:

"Professor Paton's research has had a significant impact in shaping public debate on policy relating to adolescent sexual health both in the UK and overseas. His work has presented a significant challenge to Government policy on teenage pregnancy in the UK. The Family Education Trust (FET) has made extensive use of his research in our submissions to Parliamentary Inquiries and in policy briefings. I am aware that several other organisations and commentators have similarly drawn upon his research when subjecting proposed changes in policy in this area to critical scrutiny." [F]

Paton was invited to present his research at the 2009 Battle of Ideas debate on sex education, a consultation on Sex Education Policy at the House of Commons chaired by Bob Blackman MP in October 2010 and to submit written evidence [A] to the Inquiry into Teenage Pregnancy (2012) being Chaired by Amber Rudd MP. He subsequently provided oral evidence to the Inquiry (16^th October 2012) and appeared on Newsnight (19^th December 2012) to discuss the recommendations of the Inquiry. Most recently, the research has been cited by submissions to the 2013 Scottish Parliament Inquiry into Teenage Pregnancy by several NGOs including CARE and the Christian Medical Foundation.

Paton's research in [4], [5] has featured widely in a range of media outlets, notably:

• BBC Wales TV programme `Week in, Week out' (June 2011) that critically examined the Welsh Assembly plans for free provision of emergency birth control centred on a discussion of Paton's research [3] [4] including an interview with Paton.
• Radio 5 Live Gabby Logan show (1^st February 2011)
• Sunday Times (29^th January 2011)
• Daily Telegraph (30^th January 2011 [H] and 25^th August 2012)
• Toronto Globe & Mail (3^rd February 2011)
• Times of India (31^st January 2011)
• Times Education Supplement (24^th August, 2012)

Paton's research has had a lasting effect on public discourse in the broad area of reproductive health. Further examples include periodic reference to the research in teenage pregnancy statistics and sex education articles in The Independent (29^th February 2012) [I] and BBC News Channel (26^th April 2012). Paton has given invited contributions and keynote speeches to the Westminster Health Forum Keynote Seminar (March 2009, about 150 attendees including MPs, Peers, representatives from local authorities, NGOs, health authorities), Family Education Trust Conference (June 2009, attended by about 100 members of the organisation), Anscombe Centre for Healthcare Ethics Conference (June 2010, about 50 attendees including individuals and representatives of organisations with an interest in bioethical issues) and the Anglican Mainstream Conference (May 2011, attended by about 50 members of the organisation). In each case, proceedings of the meetings were disseminated to the broader membership of the respective organisations and (in the case of the Westminster Health Forum) also to policymakers.

Sources to corroborate the impact

A. Public policy submission: Paton, David (September 2012), `Parliamentary Inquiry on Unwanted Pregnancy: written evidence submitted by Professor David Paton'.

B. Public policy submission: FRC (November 2011), Submission to Health Subcommittee Hearing `Do New Health Law Mandates Threaten Conscience Rights and Access to Care?', available from: http://downloads.frc.org/EF/EF11K02.pdf, (accessed 9^th July 2012, available on file)

C. Public policy submission: Iona Institute (April 2010), `Confidential Access to Family Planning and Teenage Pregnancy', submission to the Law Reform Commission Consultation on: Children and the Law: Medical Treatment, available from:
http://ionainstitute.eu/assets/files/Iona%20Institute%20paper.doc (accessed 9^th July 2012, available on file).

D. Report: Irish Law Reform Commission (July 2011), `Children and the Law: medical treatment', available from:
http://www.lawreform.ie/_fileupload/Reports/Children%20and%20the%20Law103%202011.pdf (available on file)

E. Director, The Iona Institute (email on file dated 17^th May 2012).

F. Family Education Trust (email on file dated 6^th March 2013).

Selected media references:

G. Washington Post (14^th February 2012), `Obama's contraception plan won't cut pregnancies', available from: http://www.washingtontimes.com/news/2012/feb/14/obamas-contraception-plan-wont-cut-pregnancies/ (accessed 9^th July 2012, available on file).

H. Daily Telegraph (30^th January 2011) `Morning-after pill handout causes rise in teenage sexual disease, study finds', available from: www.telegraph.co.uk/health/8291468/Morning-after-pill-handout-causes-rise-in-teenage-sexual-disease-study-finds.html (accessed 4th March 2013, available on file).

I. Independent (29^th February 2012), `Dramatic decline in teen pregnancies could be short-lived, campaigners fear', available from : http://www.independent.co.uk/life-style/health-and-families/health-news/dramatic-decline-in-teen-pregnancies-could-be-shortlived-campaigners-fear-7462555.html (accessed 9th July 2012 and available on file).

J. Kenny, Pat (25^th March 2010), `Teen Contraception: Interview with Professor David Paton', RTE 1, summary available at: www.rte.ie/radio1/today-with-pat-kenny/programmes/2010/0325/346892-2010-03-251/ (accessed 3^rd October 2013).

K. Pfundstein, Greg (8^th December 2011), `A political Plan B', National Review Online: The Corner, available from: http://www.nationalreview.com/corner/285249/political-plan-b-greg-pfundstein (accessed 9th July 2012 and available on file).